Mitral Valve Prolapse

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We find two valves that separate the atria from the ventricles. They are called atrioventricular valves.

On the right side, it is the tricuspid valve, and on the left, it is the mitral valve.

The Mitral Apparatus

The mitral valve is composed of a fibrous ring from the cardiac skeleton, two leaflets, chordae tendineae, and muscular pillars located at the base of the left ventricle.

Together, these structures form the mitral apparatus.

Like a sailboat

The mitral apparatus can be compared to a sailboat, with the mast representing the muscular pillars, the rigging connecting the sail to the structures, and the sail itself.

The two leaflets of the mitral valve are attached all around the fibrous ring. Their free edges are not smooth but form extensions, similar to a short net. From these extensions, true chordae tendineae arise, attaching to the muscular pillars located at the base of the left ventricle.

This configuration ensures the tightness of the valves.

Contraction of the Ventricles from the Bottom towards the Top

The heart’s electrical system coordinates the contraction of the ventricles in an ascending manner, meaning from the bottom to the top.

When the left ventricle contracts, the generated pressure pushes the blood upwards, thus closing the mitral valve.

Closure of the Normal Mitral Valve

When the mitral valve closes normally, the edges of each leaflet come together tightly. The chordae tendineae keep the leaflets in place, preventing them from folding back towards the left atrium. Thus, the mitral valve forms a barrier that prevents blood from flowing back into the atrium.

The only pathway for the blood is to pass through the aortic valve and continue its journey forward.

Mitral Prolapse

Mitral valve prolapse occurs when, upon closure, the leaflets of the mitral valve do not meet properly but instead fold back and form a bulge towards the left atrium.

In some cases, this condition can be described as the leaflets of the mitral valve “sticking out their tongue” towards the left atrium.

Most Common Valvular Abnormality

Mitral valve prolapse is the most common valvular anomaly, affecting approximately 2% of the population.

Anomaly of the Mitral Apparatus

An anomaly is considered to occur when one or both leaflets of the valve are too large, or when the valve’s chordae tendineae are too long or damaged.

The cause of damaged chordae tendineae remains somewhat unclear. The term “myxomatous degeneration” is used to describe the progressive loss of strength and resilience of these chordae.

There is a Broad Spectrum of Type of Mitral Prolapsed

Mitral valve prolapse presents a wide variability, ranging from an almost normal form, where the structure remains close to normal, to a severe form characterized by mitral valve regurgitation.

In less severe cases, the leaflets of the valve protrude into the left atrium, but the valve remains tight, thus preventing blood from flowing back into the atrium.

Loss of Tightness of the Mitral Valve

Mitral valve prolapse is indeed the primary cause of mitral valve regurgitation, also known as mitral insufficiency.

This regurgitation can vary in severity, ranging from mild to severe, depending on the amount of blood flowing back into the left atrium.

It is important to note that in some cases, mitral valve prolapse may never lead to valve regurgitation.

When mitral prolapse is associated with regurgitation, this regurgitation can worsen progressively over the years. In cases of severe regurgitation, where a large amount of blood returns to the left atrium, it can have repercussions on other cardiac structures. These repercussions include enlargement of the left atrium, dilation of the left ventricle, and impairment of its contraction capacity.

General Symptoms Associated ... Myth or Reality

In the past, mitral valve prolapse was often associated with general symptoms, particularly in women.

These symptoms frequently included chest discomfort unrelated to exertion, of varying duration, accompanied by palpitations, shortness of breath, and headaches.

The important thing is the presence or not of a mitral leak

With a more scientific approach, it is now established that it is difficult to associate vague symptoms solely with the presence of mitral valve prolapse. What matters more is the presence or absence of mitral regurgitation.

Patients with severe regurgitation may present symptoms such as fatigue or shortness of breath.

Simple Precautions

In general, it is recommended to maintain good oral hygiene.

Nowadays, it is no longer necessary to take antibiotics before visiting the dentist.

Medical follow-up

In cases where mitral regurgitation is present, regular follow-up with echocardiography is recommended to monitor the progression of this regurgitation and its effects on the heart.

If mitral insufficiency becomes severe, surgery to repair or replace the mitral valve may be necessary. The decision to opt for surgical intervention will depend on the patient’s symptoms and the impact of the regurgitation on other cardiac structures.

It is important to emphasize that most cases of mitral valve prolapse never lead to significant mitral regurgitation.